As the IOM reports in 1997 and 2001 document, there is a paucity of trained experts, educators, and researchers in palliative and end-of-life care. Physicians therefore lack expertise in palliative medicine, do not acquire the needed communication and self-reflection skills, and do not know how to work as members of an interdisciplinary team. They are unable to ameliorate the suffering of patients during active antineoplastic therapy; relieve the psychological, spiritual, and physical distress of patients who stop responding to chemotherapy agents; assist patients and their families in defining and achieving their last goals; or provide bereavement support for the survivors. This proposal describes a continuation and expansion of the previously funded year-long fellowship program in palliative and end-of-life care. Using the resources of Harvard Medical School, the Dana-Farber Cancer Institute, the Brigham and Women's Hospital, the Children's Hospital of Boston, a long-term care facility, and a community hospice, we now hope to train physicians who wish to become role models, educators, and researchers in adult or pediatric palliative medicine and end-of-life care. Training will include an adult and a pediatric tract, each with closely mentored didactic and clinical training. Required didactic training includes an introductory palliative care lecture series, palliative care grand rounds, and monthly palliative care seminars and journal club. Fellows will also be trained as palliative care educators. Fellows will receive the bulk of their clinical training as members of interdisciplinary palliative care and psychosocial oncology consult teams, and as members of a hospice team. Fellows will follow patients across treatment settings (inpatient, outpatient, home, and hospice). Other adult training sites include Anesthesia Pain Clinic, a geriatric long-term care facility, advanced cardiac/pulmonary disease or ALS clinics, the ethics committee, and chaplaincy service. For qualified fellows, a research elective is available. The fellow's progress will be formally assessed with tools designed to measure attitudes and knowledge; the fellowship director will closely monitor fellow skill development by personal observation and by discussion with other preceptors. [unreadable] [unreadable] [unreadable]